• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.12 no.1
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• pp.57-70
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• 2017

Objectives : The purpose of this study is to find out the factors affecting the cervical angle with kyphosis. Methods : We investigated 340 cases of patients who had cervical kyphosis. We used cervical angle, flexion malposition angle, odontoid process cline angle, axis-atlas cline angle, odontoid process-atlas cline angle and occiput-atlas cline angle. Correlations between cervical angle and flexion malposition angle, odontoid process cline angle, axis-atlas cline angle, odontoid process-atlas cline angle, occiput-atlas cline angle were analyzed by pearson correlation analysis. Results : The correlation between cervical angle and flexion malposition angle was p-value 0.007, and odontoid process cline angle was p-value 0.002, and axis-atlas cline angle was p-value 0.000, and odontoid process-atlas cline angle was p-value 0.000, and occiput-atlas cline angle was p-value 0.012. Conclusions : Flexion malposition angle, odontoid process cline angle are inversely proportional to cervical angle. And correlation is statistically significant(p<0.01). Axis-atlas cline angle, odontoid process-atlas cline angle are proportional to cervical angle. And correlation is statistically significant(p<0.01). Occiput-atlas cline angle is proportional to cervical angle. And correlation is statistically significant(p<0.05).

• Journal of Oral Medicine and Pain
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• v.21 no.1
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• pp.197-206
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• 1996

This study ws performed to investigate the relationship between cervical curvature and the spatial position of the posterior part of the atlas imaged in the lateral cephalograph. Sixty six patients with temporomandibular disorders(TMD) and twenty dental students were selected for patients group and control group, respectively. The average age of patients group was 26.3 years, and 24.9 years in control group. Measured variables were cervical depth, upper space between the atlas and the base of the occiput, lower space between the atlas and the spinous process of the axis, rea of the posterior part of the atlas imaged in the lateral cephalograph, and the cervical curvature passing through the uppermost point in dorsal side of Dens of the Axis to the lowermost and rearmost point of the 5th cervical vertebra. The reliability of the method used for measuring cervical curvature with curved ruler was also tested. The results obtained were as follows : 1. Cervical depth of patients group was 122.9mm and significantly shorter than that of control group, in which cervical depth was 131.9mm, and cervical depth was significantly correlated with other variables in all subjects. 2. Upper space was greater in patients group, but total space including upper and lower space showed no difference between the two groups. The average value of total space was 26.5mm. 3. Area of the posterior part of the atlas was 168.2$\textrm{mm}^2$ in patients group, and 186.5$\textrm{mm}^2$ in control group with significant difference between the two groups. 4. Average range of radius of cervical curvature were 33-40cm and there was no difference between the two groups. 5. There was no significant correlation between the cervical curvature and the area of the posterior arch of the atlas. 6. The method using curved ruler for measuring cervical curvature could be accepted as a reliable method.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.528-533
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• 2015

Objective : We sought to examine anatomic variations of the atlas and the clinical significance of these variations. Methods : We retrospectively reviewed 1029 cervical 3-dimensional (3D) CT images. Cervical 3D CT was performed between November 2011 and August 2014. Arcuate foramina were classified as partial or complete and left and/or right. Occipitalization of the atlas was classified in accordance with criteria specified by Mudaliar et al. Posterior arch defects of the atlas were classified in accordance with criteria specified by Currarino et al. Results : One hundred and eight vertebrae (108/1029, 10.5%) showed an arcuate foramen. Bilateral arcuate foramina were present in 41 of these vertebrae and the remaining 67 arcuate foramina were unilateral (right 31, left 36). Right-side arcuate foramina were partial on 18 sides and complete on 54 sides. Left-side arcuate foramina were partial on 24 sides and complete on 53 sides. One case of atlas assimilation was found. Twelve patients (12/1029, 1.17%) had a defect of the atlantal posterior arch. Nine of these patients (9/1029, 0.87%) had a type A posterior arch defect. We also identified one type B, one type D, and one type E defect. Conclusion : Preoperative diagnosis of occipitalization of the atlas and arcuate foramina using 3D CT is of paramount importance in avoiding neurovascular injury during surgery. It is important to be aware of posterior arch defects of the atlas because they may be misdiagnosed as a fracture.

• Journal of Trauma and Injury
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• v.26 no.1
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• pp.30-33
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• 2013

A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.

• Physical Therapy Rehabilitation Science
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• v.10 no.2
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• pp.134-140
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• 2021

Objective: The purpose of this study was to investigate the alteration of upper cervical manipulation to autonomic nervous system (ANS) through the heart rate variability(HRV) analysis in young healthy individuals. Design: Two-group pretest-posttest design. Methods: Thirty four young healthy participants (17 males and 17 females) were randomized into the 2 groups, such as the upper cervical manipulation group (UCM group, n=17), neck stretching group (NS group, n=17). UCM group received a upper cervical manipulation, especially on the atlas, and NS group did stretch for both side of upper trapezius and levator scapular. For the UCM, Atlas mobility was checked by therapist and thrust was given once at the posterior arch of Atlas. HRV was measured before and after intervention to investigate ANS alteration. After the intervention, both groups were given 3 minutes break-time before measuring HRV. Results: The UCM group showed significant differences in ANS Activity, Stress Resistance, Stress index and Fatigue Index (p<0.05) while no differences in NS group with before and after intervention. There were significant differences in ANS Activity, Stress Resistance, and Fatigue Index between groups (p<0.05). Conclusions: This study suggected that upper cervical manipulationhas positive effects on the ANS activity, stress resistance, and fatigue index.

• Neurospine
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• v.15 no.4
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• pp.323-328
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• 2018

The author reviews the various types of cervical fusion that are associated with instability of the craniovertebral junction. Assimilation of the atlas, C2-3 fusion, the Klippel-Feil abnormality, and pancervical fusion are amongst the more common types of bone abnormalities. It is conceptualised that these types of cervical fusion are not related to any kind of embryological dysgenesis or fault, but instead emerge due to longstanding muscle spasms of the neck in response to atlantoaxial instability. Such bone fusions could be secondary protective responses to longstanding atlantoaxial instability.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.3
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• pp.183-187
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• 2018

Complex cervical spine fractures are a serious complications of maxillofacial trauma and associated with high mortality and neurological morbidity. Strict vigilance in preventing further insult to the cervical spine is a crucial step in managing patients who are at risk for neurologic compromise. We report a rare case of a right transverse process of atlas fracture with right-sided vertebral artery injury that was associated with a comminuted fracture of the body and angle of the mandible, which restricted mouth opening. Airway management was performed by an awake fiber-optic nasotracheal intubation, where neck movement was avoided with a cervical collar. Vertebral artery injuries may have disastrous consequences, such as basilar territory infarction and death, and should be suspected in patients with head and neck trauma. After mandibular plating, the patient was on cervical collar immobilization for 12 weeks and anti-coagulant therapy.

• Journal of Korean Neurosurgical Society
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• v.49 no.3
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• pp.178-181
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• 2011

Congenital anomalies in arches of the atlas are rare, and are usually discovered incidentally. However, a very rare subgroup of patients with unique radiographic features is predisposed to transient quadriparesis after minor cervical or head trauma, A 46-year-old male presented with a 2-month history of tremor and hyperesthesia of the lower extremities after experiencing a minor head trauma. He said that he had been quadriplegic for about 2 weeks after that trauma. Radiographs of his cervical spine revealed bilateral bony defects of the lateral aspects of the posterior arch of C1 and a midline cleft within the anterior arch of the atlas. A magnetic resonance imaging revealed an increased cord signal at the C2 level on the T2-weighted sagittal image. A posterior, suboccipital midline approach for excision of the remnant posterior tubercle was performed. The patient showed significant improvement of his motor and sensory functions. Since major neurologic deficits can be produced by a minor trauma, it is crucial to recognize this anomaly.

• Journal of Acupuncture Research
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• v.20 no.6
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• pp.27-35
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• 2003

Objective: We intended to show the relation between whiplash injury and deviation of upper cervical through analysing patients having deviation of upper cervical injuried by whiplash. Methods: We chose 40 patients who have been admitted for whiplash injury syndrome in vertebral-joint center of Conmaul oriental medical hospital during 2001.10.1-2003.10.15. We examined cervical simple X-ray of them according to the traffic accident patterns and the position in the veicle. Results: The 97% of the cases showed AS deviation and the 95% of them complained neck pain. The first cases collided from the back on the driving seat showed AS deviation. The second cases collided from the front on the back seat showed AS deviation of left lateral misalignment of atlas. The third cases collided from the front on the assistant seat showed AS deviation of right lateral misalignment of atlas.

• Journal of International Society for Simulation Surgery
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• v.3 no.1
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• pp.28-32
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• 2016

Background Congenital muscular torticollis (CMT) is a benign condition. With early diagnosis and appropriate management, it can be cured completely, leaving no residual deformity. However, long-standing, untreated CMT can lead to permanent craniofacial deformities and asymmetry.Methods Nineteen patients presented to the author with congenital muscular torticollis. Three dimensional computed tomography (3-D CT) scans was obtained upon patient’s admission. Adjustment of skull’s position to Frankfort horizontal plan was done. Cervical vertebral segmentation was done which allowed a 3D module to be separately created for each vertebra to detect any anatomical or positional changes.Results The segmented vertebrae showed an apparent anatomical changes, which were most noticeable at the level of the atlas and axis vertebrae. These changes decreased gradually till reaching the seventh cervical vertebra, which appeared to be normal in all patients. The changes in the atlas vertebra were mostly due to its intimate relation with the skull base, while the changes of the axis were the most significantConclusion Cervical vertebral segmentation is a reliable tool for isolation and studying cervical vertebral pathological changes of each vertebra separately. The accuracy of the procedures in addition to the availability of many software that can be used for segmentation will allow many surgeons to use segmentation of the vertebrae for diagnosis and even for preoperative simulation planning.